Provider Demographics
NPI:1598962482
Name:MONSON, BRYAN KAY (MD MBA)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:KAY
Last Name:MONSON
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 S 100 W STE A
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-6093
Mailing Address - Country:US
Mailing Address - Phone:435-787-7200
Mailing Address - Fax:435-787-7203
Practice Address - Street 1:810 S 100 W STE A
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-6093
Practice Address - Country:US
Practice Address - Phone:435-787-7200
Practice Address - Fax:435-787-7203
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ46712207W00000X
NMMD2013-0312207W00000X
UT356947-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT356947-1205OtherSTATE MEDICAL LICENSE